Can an HMO and its doctors be sued for medical malpractice?

An HMO doctor can be sued for negligent medical treatment, just as he or she would be if the care was not provided by an HMO. If the doctor is an employee of the HMO, you may sue the HMO for the actions of the doctor under the legal concept of “vicarious liability.” “Vicarious liability” in the medical setting means that the negligent doctor was acting as the agent of the HMO and therefore the HMO can be held responsible for the doctor’s carelessness. Claims directly against the HMO for medical malpractice are difficult, as the HMO has to be shown to have been practicing medicine; however, direct claims against the HMO for negligent selection, retention and/or supervision of its healthcare providers are possible. For example, if an HMO fails to terminate a physician with a record of substance abuse that has resulted in injuries to patients, it may be liable for negligently keeping that doctor on its staff.

If inappropriate decisions in the treatment of patients result from an HMO’s cost saving mechanisms (e.g., experimental treatment denials), then the HMO may be liable for the injuries to a patient; however, because of federal regulations and constantly changing laws, lawsuits directly against HMOs are extremely complex and difficult to win.

If you suspect that an HMO is responsible for your injuries, you should contact an experienced medical malpractice attorney in your area.